Clinical pellagra is a multiple vitamin-deficiency disease. The clinical manifestations include dermatitis, diarrhea, and dementia; the result is often death. Photosensitivity has also been associated with pellagra. Other clinical findings may depend on the nutritional status of the patient. Pellagrins may not have specific cutaneous pathological findings, although necrolytic migratory erythema has been reported in clinical pellagra. Most pellagrins respond to niacin combined with a high-protein diet, although other concomitant vitamin deficiencies may prevent the use of niacin. Clinical pellagra should be considered in the differential diagnosis of patients with chronic alcoholism, malnutrition, and amino acid imbalance.